AB1398 CORRELATES OF CANCELLED HEALTHCARE APPOINTMENTS IN PATIENTS WITH SYSTEMIC SCLEROSIS DURING THE COVID-19 PANDEMIC
Authors: N. Dorr, P. Fennell, L. Shapiro
Journal: Annals of the Rheumatic Diseases (2022)

Background Rheumatologists have noted challenges in treating patients with systemic sclerosis (SSc) during the COVID-19 pandemic, such as patients on immunosuppressants and those with preexisting pulmonary issues. 1 Also of potential concern was patients delaying treatment due to fears of COVID. Objectives This study examined to what extent patients with SSc cancelled health-care appointments due to fears of COVID, how this correlated with their mental and physical functioning, and their levels of anxiety and depression. Methods Participants were 60 people with SSc who had not had COVID-19 or been vaccinated for COVID. Participants had a mean age of 58 years ( SD =11.5) and were primarily female (92%) and white (87%). Participants completed an online survey after learning about it from a scleroderma organization newsletter or at their visit with a rheumatologist specializing in scleroderma in New York State, USA. Data were collected August 2020 through March 2021. Participants completed measures assessing health-related appointments attendance, Patient Reported Outcome Measurement Information System (PROMIS) measures (anxiety, depression, fatigue, sleep disturbance, pain intensity, physical function), coping strategies to deal with the pandemic, and reported functioning relevant to SSc (hand, gastrointestinal, dyspnea, and Raynaud’s disease). Results Due to COVID-19 concerns, 28 respondents (47%) cancelled one or more appointments with their primary care physician, specialist, physical or occupational therapist, pulmonologist, or dentist. Compared to those who did not cancel appointments due to COVID concerns, participants who cancelled reported higher anxiety, t (58) = 2.46, p = .02, higher sleep disturbance, t (56) = 3.31, p = .002, worse physical functioning, t (56) = 2.00, p = .05, more constipation, t (55) = 2.05, p = .045, and lower positive reframing as a coping strategy, t (56) = 2.08, p = .04. Many participants reported moderate or severe anxiety (36%), depression (22%), fatigue (32%), sleep disturbance (28%), and physical dysfunction (40%). As shown in Table 1, anxiety scores were positively correlated with scores on measures of fatigue, sleep disturbance, physical dysfunction, diarrhea, and the coping strategies of substance use, self-distraction, emotional support, behavioral disengagement, and venting. Depression scores were positively correlated with scores on measures of fatigue, sleep disturbance, physical dysfunction, pain intensity, dyspnea, diarrhea, and behavioral disengagement as a coping strategy. Table 1. Correlations Between Anxiety and Depression with Patient-Reported Outcomes and Coping with the Pandemic Measure Anxiety Depression Fatigue .38 ** .43 ** Sleep disturbance .35 ** .34 ** Physical dysfunction .28 * .49 ** Pain intensity .16 .36 ** Reflux .25 .15 Distention/bloating .28 * .24 Fecal soilage -.001 .07 Diarrhea .34 ** .28 * Constipation .21 -.03 Dyspnea .18 .32 * Raynaud’s disease activity -.08 -.02 Hand functioning .06 .25 Coping strategy Substance use .29 * .21 Self-distraction .32 * .18 Behavioral disengagement .37 ** .41 ** Using emotional support .43 ** .06 Venting .34 ** .14 Note . * p &lt; .05; ** p &lt; .01 Conclusion Almost half of participants cancelled one or more health appointments due to COVID fears. This subgroup reported significantly higher anxiety, sleep disturbance, constipation, worse physical functioning, and less coping with the pandemic by looking for the positive. Anxiety and/or depression also played a role in 42% of SSc patients and were related to a variety of worse mental and physical health correlates. Future research should examine the extent to which changes in health-related care during the pandemic have implications for disease progression in patients with SSc. References [1]Orlandi M, Lepri G, Bruni C, et al. The systemic sclerosis patient in the COVID-19 era: The challenging crossroad between immunosuppression, differential diagnosis and long-term psychological distress. Clin. Rheumatol. 2020;39(7):2043-2047. doi:/10.1007/s10067-020-051932 Disclosure of Interests Nancy Dorr: None declared, Patricia Fennell: None declared, Lee Shapiro Consultant of: Actelion (January 2020, participated as consultant for Actelion as part of a panel of rheumatologists regarding future needs in management of pulmonary hypertension.)